Annals of Surgical Treatment and Research最新文献

Purpose: The relationship between tacrolimus intrapatient variability (IPV) and its metabolism-associated single-nucleotide polymorphisms (SNPs) in liver transplantation (LT) remains unclear. Moreover, the influence of donor SNP on recipient IPV is poorly understood. Our objective was to investigate how SNPs affect tacrolimus IPV by analyzing both donor and recipient SNP data in LT.

Methods: This retrospective study examined the association between tacrolimus IPV and eight specific SNPs in 50 adult LT recipients and 50 LT donors genotyped for CYP3A5, ABCB1, ABCC2, and POR genes and their SNPs. Recipients were divided into high IPV (≥30) and low IPV (<30) groups based on 3-12 months after LT IPV calculations. Multivariate logistic regression was used to identify risk factors for high IPV. Post-LT long-term outcomes were also compared between the groups.

Results: Two SNPs were significantly associated with high IPV in multivariate analysis. Recipient ABCB1 1236C>T genotypes CT and CC (odds ratio [OR], 13.969; 95% confidence interval [CI], 1.738-112.300; P = 0.013), donors' CYP3A5 6986A>G genotypes GA and GG (OR, 4.390; 95% CI, 1.005-19.178; P = 0.049), and glucose ≥120 mg/dL at 3 months (OR, 6.494; 95% CI, 1.300-32.168; P = 0.024) were associated with high IPV. However, post-LT long-term outcomes were similar between the groups.

Conclusion: SNPs of donor CYP3A5 and recipient ABCB1 can significantly influence tacrolimus IPV in patients undergoing living donor LT. Identifying these SNPs can help determine high IPV-prone patients, facilitate close monitoring of high IPV-susceptible groups, and improve outcomes.

Purpose: In intrahepatic cholangiocarcinoma (ICC), the interactions among CA19-9, CA125, and CEA are not yet fully understood. This study aims to investigate the relationship between a combined grading system of CA19-9, CA125, and CEA (3C grade) and the prognosis of ICC patients, as well as its predictive capability for prognosis.

Methods: The patients were categorized into different 3C grades based on preoperative serum levels of CA19-9, CA125, and CEA to explore the relationship between 3C grade and overall survival (OS) and recurrence-free survival (RFS), assessing the predictive value of 3C grade for OS and RFS.

Results: A total of 535 eligible patients were included and were classified into different 3C grade groups. Significant differences were observed among different 3C grade groups in clinical characteristics such as tumor size (P = 0.006) and lymph node metastasis (P = 0.006). The Kaplan-Meier curves demonstrated significant differences in OS and RFS among the different 3C grade groups (P < 0.001). The receiver operating characteristic curve analysis revealed that the 3C grade had superior predictive value for OS and RFS compared to individual tumor markers (P < 0.05 for each).

Conclusion: This study revealed that the 3C grade was identified as an independent prognostic factor for OS and RFS after radical surgery of ICC, demonstrating superior predictive value for OS and RFS compared to single tumor markers. The 3C grade model holds promise to assist clinicians in preoperative assessment of ICC patients undergoing radical surgery, thereby aiding in the development of personalized treatment strategies.

Purpose: Laparoscopic appendectomy, a routine surgical procedure for acute appendicitis, is commonly performed in general hospitals. However, postoperative outcomes based on surgical subspecialty have not been well established. This study aimed to compare surgical outcomes of laparoscopic appendectomy across different surgical subspecialties using risk-adjusted cumulative summation (RA-CUSUM) analysis.

Methods: A retrospective analysis was conducted on 631 patients undergoing laparoscopic appendectomy between July 2020 and December 2022. Surgeons were categorized into gastrointestinal (GI) or non-GI groups and senior or young groups. Surgical failure was defined as operation time exceeding the mean plus 2 standard deviations, presence of postoperative complications, or readmission within 30 days after surgery. RA-CUSUM analysis was employed to evaluate surgical failure within each group.

Results: The GI group performed more partial cecectomies (P = 0.017) and had longer operation times (P = 0.019) than the non-GI group. The senior group exhibited shorter operation time (P < 0.001), reduced length of stay (P = 0.011), and a higher complication rate (P < 0.001) than the young group. RA-CUSUM analysis indicated a decrease in surgical failure as accumulation progressed in both senior and young groups, as well as in the GI and non-GI groups.

Conclusion: Outcomes of laparoscopic appendectomy varied by subspecialty and length of experience. However, each surgeon showed trends of decreasing surgical failure over time. These results suggest that the surgeon's subspecialty minimally affects the outcomes of laparoscopic appendectomy, reflecting its fundamental nature within general surgery.

Purpose: Huge (≥10 cm) hepatocellular carcinoma (HCC) poses significant treatment and prognosis challenges. This study aimed to determine whether preoperative transarterial chemoembolization (TACE) for huge HCC is necessary.

Methods: This single-center, retrospective cohort study evaluated 435 patients with huge HCC who underwent upfront hepatectomy or hepatectomy after preoperative TACE from January 2009 to December 2018. TACE's impact on survival and prognostic factors, including microvascular invasion (MVI) and satellite nodules (SNs), was analyzed.

Results: The preoperative TACE group (n = 33) had a lower incidence of MVI (P = 0.009) and higher postoperative morbidity (P = 0.001), particularly pleural effusion (P = 0.004) and Clavien-Dindo class III-IV complications (P = 0.033), compared with the upfront hepatectomy group (n = 402). Short-term mortality (P = 0.828) and recurrence within 6 months (P = 0.654) were comparable between groups. The 1-, 3-, and 5-year survival curves showed no significant between-group differences in recurrence-free survival (RFS) (P = 0.172) and overall survival (OS) (P = 0.450). Local regional therapy for intrahepatic recurrences and surgical resection for extrahepatic recurrences were associated with better OS. MVI, SN, and hepatic vein tumor thrombosis were identified as significant risk factors for poorer RFS and OS. In patients without SN, preoperative TACE improved RFS (P = 0.039) but not OS.

Conclusion: Preoperative TACE for huge HCC was associated with reduced MVI but did not improve RFS and OS. Survival outcomes were more significantly influenced by SN, suggesting that upfront hepatectomy without TACE should be prioritized.

Purpose: This study was designed to investigate the efficacy and safety of radiofrequency ablation (RFA) for treating thyroid nodules (TNs).

Methods: We retrospectively included the patients who underwent RFA for TNs in our hospital between January 2020 and December 2023. Preoperative and postoperative data including age, sex, body mass index, and thyroid hormone levels were collected from each patient. The efficacy of RFA on TNs was analyzed by evaluating the volume reduction (VR) and volume reduction rate (VRR) at postoperative months 1, 3, 6, and 12, respectively. In addition, the efficacy of RFA on nodule composition and postoperative complications was evaluated. Finally, a subgroup analysis was conducted to evaluate the potential risks.

Results: VR at postoperative month 12 was significantly higher than those at postoperative months 1, 3, and 6, respectively (all P < 0.001). VRR at month 12 was significantly higher than that of months 1, 3, and 6, respectively (all P < 0.001).

Conclusion: RFA is an effective option for treating TNs with good safety. VR and VRR showed significant increase after RFA compared with the pretreatment levels.

Purpose: Glycolytic enzymes have been extensively studied in various cancer types, revealing their aggressive characteristics and roles in tumor progression. This study aimed to determine whether the expression of glycolytic enzymes is associated with aggressiveness in the presence or absence of chronic lymphocytic thyroiditis (CLT).

Methods: The expression of hexokinase 2, lactate dehydrogenase A (LDHA), pyruvate kinase isoform M2 (PKM2), glucose transporter 1 (GLUT1), and monocarboxylate transporter 4 (MCT4) was examined in 233 papillary thyroid carcinoma (PTC) specimens by immunohistochemistry. We evaluated whether the expression of these glycolytic enzymes correlates with lymph node metastasis, extrathyroidal extension (ETE), and recurrence rate, both with and without CLT. In addition, we analyzed the correlation between glycolytic enzyme messenger RNA expression and risk factors in PTC using The Cancer Genome Atlas.

Results: All glycolytic enzymes and transporter proteins were overexpressed in PTC compared with normal tissue. PKM2 expression was most highly correlated with the other glycolytic enzymes. High PKM2 expression was significantly linked to increased recurrence risk in patients without CLT (hazard ratio, 1.76; 95% confidence interval, 1.01-3.06; P = 0.046), but this association was not observed in those with CLT.

Conclusion: Overexpression of LDHA, PKM2, GLUT1, and MCT4 is associated with PTC. CLT is significantly associated with an increased incidence of gross ETE and, paradoxically, with a reduced recurrence rate in PTC. LDHA expression was lower in the presence of CLT, whereas PKM2 remained consistently linked to a higher recurrence rate in its absence. Among the evaluated glycolytic enzymes, PKM2 may serve as a biomarker for recurrence in PTC.

Purpose: Gastric perforation remains a life-threatening condition despite advances in medical therapies and surgical techniques. In clinical emergencies involving gastric perforation, distinguishing between benign and malignant etiologies remains uncertain until histological confirmation is obtained.

Methods: This study analyzed 79 patients who underwent emergency gastrectomy for gastric perforation between 2010 and 2024. Patients were categorized into ulcer and cancer groups based on pathological findings. Clinical data, including preoperative conditions and postoperative outcomes, were analyzed using univariate and multivariate analyses.

Results: Elderly (aged ≥75 years), symptom duration ≥48 hours, and American Society of Anesthesiologists physical status classification IV-E were significant risk factors for postoperative mortality. The cancer group had longer operation times, while ventilator use was more common in the ulcer group. No significant differences were observed in overall mortality rates.

Conclusion: Emergency gastrectomy can be a viable treatment for gastric perforation in regions with a high incidence of gastric cancer. However, patients with advanced age, delayed symptom onset, or poor physical status require careful surgical planning. Tailored strategies may improve outcomes, particularly in high-incidence regions for gastric cancer.

Purpose: Although neoadjuvant therapy (NAT) has been applied in patients with borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC), limited data on long-term outcomes are available to support its role as a potentially curable therapeutic option. This study assessed the probability of being statistically cured among these patients.

Methods: The literature search was conducted focusing on previous studies that investigated the long-term recurrence-free survival rates of patients with BR-PDAC after NAT followed by radical resection. The reference cohort data were extracted from studies including patients undergoing upfront radical resection for resectable PDAC. Pseudo-individual patient data were reconstructed from the original papers. A non-mixture cure model was adopted to estimate the statistical cure fraction.

Results: Twelve retrospective studies reporting long-term recurrence-free survival after NAT followed by radical resection for patients with BR-PDAC were secondarily analyzed. The probability of being statistically cured in these patients was 8.1% (95% confidence interval [CI], 5.4%-11.5%), which was lower than that of the reference cohort of 5 retrospective studies (14.7%; 95% CI, 13.2%-16.4%). There was a statistically significant difference between the 2 groups (hazard ratio, 1.110; 95% CI, 1.007-1.224).

Conclusion: From this study, we concluded that a cure can be expected in around eight percent of patients with BR-PDAC after NAT followed by radical resection, which would be helpful in counseling patients, as well as deciding whether to perform the surgery.

Purpose: Although Korea's medical care uses advanced technology, there are not enough doctors working in rural areas, and fewer doctors are working in challenging fields such as surgery. Medical care in Türkiye is very cost-effective for patients, but doctors have too many patients and too much work. This study compared the healthcare systems of the 2 countries and the gaps felt by surgeons.

Methods: A comparative analysis was conducted using a comprehensive literature review and a questionnaire involving medical professionals from various working positions in both countries.

Results: Doctors in both countries felt that there was a large medical gap between regions and reported that the number of doctors was small. Turkish doctors experience excessive patient overload, contributing to high stress and feelings of overwork. They also showed lower job satisfaction than in Korea. The common reasons for the low preference for general surgery residencies include intense training, excessive workload, and high risk in both countries.

Conclusion: This study identified the key challenges in medical and surgical training in Korea and Türkiye. In Korea, shortages can be addressed by reforms in general surgery residency, the development of a balanced residency selection system, and the provision of work opportunities for non-Korean professionals. In Türkiye, improving remuneration and alleviating unsafe work environments is urgent. Both countries should incentivize rural services to ensure balanced doctor distribution. Collaborative initiatives informed by these findings can enhance medical education and healthcare delivery in both countries.